Background: Chronic pulmonary tuberculosis (PTB) often leads to persistent pulmonary dysfunction even after completion of anti-tubercular therapy. Understanding the pattern and extent of pulmonary function impairment is crucial for long-term management and rehabilitation. Objectives: To evaluate pulmonary function parameters and classify spirometric patterns among patients with chronic pulmonary tuberculosis in a tertiary care hospital. Methods: This hospital-based observational study included 100 adult patients with a documented history of pulmonary tuberculosis who had completed treatment at least six months prior. Demographic data, smoking history, and spirometry results were recorded. Pulmonary function tests (PFTs) were performed using a standardized protocol, and parameters including FEV₁, FVC, FEV₁/FVC ratio, and PEFR were analyzed. Patients were categorized into obstructive, restrictive, mixed, or normal spirometric patterns based on standard criteria. Results: The study cohort had a mean age of 45.3 ± 12.6 years, with 67% being male and 42% identified as current or former smokers. Abnormal pulmonary function was observed in 86% of patients, with obstructive (38%) being the most common pattern, followed by restrictive (29%) and mixed (19%) types. Mean FEV₁ and FVC were 1.72 ± 0.54 L (61.8% predicted) and 2.21 ± 0.62 L (68.3% predicted), respectively. Obstructive defects were significantly more common among smokers. Conclusion: Chronic pulmonary tuberculosis is associated with significant and lasting pulmonary function impairment, with a predominance of obstructive and restrictive patterns. Spirometry should be routinely employed in post-TB care to guide long-term pulmonary rehabilitation strategies.

Background: Bone cancer, though rare, is a serious malignancy with aggressive progression and poor outcomes when diagnosed late. Early identification of warning signs—such as persistent localized pain, swelling, fatigue, pathological fractures, and weight loss—is critical for timely intervention. This study aimed to assess the level of knowledge regarding bone cancer warning signs among the general adult population in Himachal Pradesh and to examine socio-demographic factors associated with awareness. Materials and Methods: A descriptive, cross-sectional study was conducted among 400 adults (≥18 years) across urban and rural districts of Himachal Pradesh. Participants were recruited through purposive and convenience sampling. A structured, bilingual (Hindi/English) Google Form questionnaire, validated by oncology and public health experts, assessed awareness of bone cancer symptoms, risk perception, and health-seeking behavior. Each correct response was awarded one point (maximum score: 20). Awareness levels were categorized as Very Good (17–20), Good (13–16), Fair (9–12), and Poor (0–8). Data were analyzed using Epi Info Version 7. Chi-square tests evaluated associations between awareness levels and socio-demographic variables (p < 0.05). Results: Among the 400 participants, 30.8% demonstrated Very Good knowledge, 35.3% Good, 22.5% Fair, and 11.5% Poor awareness. High recognition was observed for symptoms such as persistent bone pain (70.8%), unexplained swelling (68.8%), and the importance of early detection (73.0%). However, knowledge gaps remained in understanding that pain may not always be an early symptom (59.5%) and in differentiating bone cancer from arthritis (62.8%). Awareness was significantly associated with age (p = 0.027), education level (p < 0.001), occupation (p = 0.041), and place of residence (p = 0.038), with younger, urban, and better-educated individuals scoring higher. Gender differences were not statistically significant (p = 0.185). Conclusion: While awareness of bone cancer warning signs is moderate to high in Himachal Pradesh, significant knowledge gaps persist—particularly among older adults, rural residents, and those with limited education. Strengthening public awareness through grassroots campaigns and integrating bone cancer education into primary healthcare services could significantly reduce diagnostic delays and improve clinical outcomes in this vulnerable population.

Background: Osteoporosis is a silent yet progressive skeletal disorder that leads to decreased bone mass and increased fracture risk, posing a significant public health challenge, especially among aging populations. This study aimed to assess the level of awareness and identify misconceptions about osteoporosis among the adult population of Himachal Pradesh, while examining the influence of socio-demographic variables on knowledge levels. Materials and Methods: A cross-sectional, descriptive study was conducted using a structured, self-administered questionnaire distributed digitally across Himachal Pradesh. The survey included 400 adult participants, selected via convenience sampling, excluding healthcare professionals to minimize bias. The questionnaire comprised two sections: socio-demographic information and 20 multiple-choice questions assessing knowledge and misconceptions related to osteoporosis. Scoring was categorized into four awareness levels: Very Good, Good, Fair, and Poor. Data were analyzed using Epi Info Version 7, with chi-square tests applied to determine associations between knowledge levels and demographic factors. Results: Out of 400 respondents, 66.0% demonstrated Very Good or Good awareness, while 33.5% had Fair or Poor knowledge scores. Awareness was high regarding calcium and vitamin D (81.0%), osteoporosis definition (76.5%), and sunlight's role in vitamin D synthesis (77.0%). However, lower awareness was noted for risk factors like high-protein diets (46.5%), long-term steroid use (55.0%), and family history (51.5%). Significant associations were found between awareness levels and age (p = 0.007), education (p < 0.001), and residence (p = 0.011), with urban, educated, and middle-aged participants displaying higher awareness. Gender and occupation were not significantly associated with knowledge scores. Conclusion: While overall awareness of osteoporosis in Himachal Pradesh is moderately encouraging, significant knowledge gaps persist—particularly among rural residents, the elderly, and those with lower educational attainment. Public health efforts must prioritize culturally and geographically tailored education campaigns to enhance bone health literacy and preventive practices in this vulnerable population, ultimately aiming to reduce the burden of osteoporosis-related complications.

Background:  In older adults, the consumption of potentially inappropriate medications (PIMs) is an essential concern that contributes to serious medication-related problems. Notably, senior citizens frequently receive numerous medications; hence, medication errors are prevalent. The outcome measures of this study were to investigate PIM use in older adults in a private teaching hospital. Methods: A large hospital's inpatient medical data were the subject of a cross-sectional analysis. The study covered all patients receiving treatment who were older than 60. The BC was used to evaluate the PIM prescriptions. To characterize the PIM usage patterns, descriptive statistics and logistic regression were performed.  Results:  The study included 295 hospital stays by older adults (60 years of age) with a mean age of 67.25 (± 6.2 years). About 78% of participants were males. The average PIMs prescribed were 64% of which 65% contained at least one PIM per prescription, 25% and 10% contained two and three respectively. The PIMs associated with drug interactions was 57%. In older adults’ polypharmacy (96%) and chronic comorbidities (60%) were linked to a higher probability of PIM use.  Conclusions:  This study identified crucial areas that should be addressed in future interventions to enhance older persons at risk of PIM's drug-prescribing behaviours.

INTRODUCTION: Cardiovascular diseases (CVDs) represent a formidable challenge to global health, posing significant burdens on individuals, communities, and healthcare systems worldwide. These diseases, which affect the heart and blood vessels, encompass a diverse array of conditions, ranging from coronary artery disease and heart failure to stroke and peripheral vascular disease. Despite advances in medical science and public health initiatives, CVDs remain the leading cause of morbidity and mortality globally. MATERIALS & METHODS: This cross-sectional study was conducted to estimate the prevalence of risk factors of cardiovascular diseases (CVD’s) among healthcare workers in tertiary care hospitals in Hyderabad. The city was divided into five zones: North, South, East, West, Central and one hospital was selected from each zone based on feasibility criteria. The feasibility criteria included the hospital’s willingness to participate, ease of access and the availability of a sufficient number of healthcare workers. RESULTS: A significant portion of individuals have a family history of Diabetes (32%) and Hypertension (28.77%). CAD (Coronary Artery Disease ) in family history is reported by (17.4%). A smaller percentage of individuals have a past history of CAD (3.8%) . Stroke has not been reported in past history. Cardiac Surgery is reported at a very low percentage (0.4%). This parameter indicates the body weight of individuals. Males have a weig ht range from 50 to 119 kg, while females have a range from 40 to 96 kg.Height (cm): This parameter shows the height of individuals. Males are generally taller, with a range from 1.5 to 1.9 meters, compared to females who have a range from 1.4 to 1.7 meters.  CONCLUSION: Implementing these measures is essential to protect the health of healthcare workers, enabling them to remain effective in their professional roles and maintain their overall well-being. Future research should explore specific interventions tailored to this population and evaluate their effectiveness over time.

Introduction: Papillary muscles are integral to the function of atrioventricular valves, ensuring proper valve closure during systole. Variations in their number and morphology can have significant clinical implications, particularly in surgical interventions and the understanding of certain cardiac pathologies. Materials and Methods: This descriptive observational study analyzed 25 adult human cadaveric hearts obtained from autopsy specimens. Standard dissection techniques were employed to examine the number, position, and morphology of papillary muscles in both ventricles. Results: The right ventricle typically exhibited three papillary muscles—anterior, posterior, and septal—in 84% of specimens, while 16% displayed only two groups. The left ventricle predominantly had two papillary muscles in 73% of hearts, with additional groups observed in the remaining specimens. Variations in the number of muscle bellies were noted, with some specimens exhibiting up to five bellies in a single papillary muscle. Conclusion: Significant variations exist in the number and morphology of papillary muscles, which are crucial for clinicians to consider during diagnostic evaluations and surgical procedures to prevent potential complications.

Background: Sudden death in elderly individuals poses significant challenges in both clinical and forensic practice due to its often-unexpected nature, complex comorbidities and subtle premonitory symptoms. This study aimed to investigate the underlying causes, associated risk factors and circumstantial patterns of sudden death among the elderly through a forensic lens. Materials and Methods: This retrospective cross-sectional study was conducted over a period of two-years. All elderly individuals (≥60 years) who died suddenly and underwent medicolegal autopsy were included. Data were extracted from autopsy records conducted by authors, histopathology report, toxicology reports and police inquests. Causes of death were categorized and statistical associations were analyzed using SPSS version 25, with a p-value of <0.05 considered significant. Results: Out of 180 cases, most were males (60%) and aged between 60–69 years (48.3%). The predominant cause of death was cardiovascular in origin (50%), with myocardial infarction and coronary artery disease being most common. Respiratory causes accounted for 20%, followed by central nervous system causes (16.1%), gastrointestinal/hepatic causes (7.8%), miscellaneous natural causes (3.9%) and unnatural causes (2.2%). Histopathological findings supported ischemic heart disease in a significant number of cases. Most deaths occurred at home (60%) and during nighttime (52.2%). Chest pain was the most frequently reported symptom (32.2%) and strongly associated with cardiovascular deaths (p < 0.001). Toxicological analysis showed no substances in 76.7%. Significant associations were found between sex and cardiovascular deaths (p = 0.020), age and CNS causes (p = 0.045) and location of death and respiratory causes (p = 0.011). Conclusion: Cardiovascular disease remains the leading cause of sudden death among the elderly, with a considerable number occurring silently and outside of healthcare settings. Comprehensive autopsy, including histopathological and toxicological analyses, is essential in identifying the cause of death and guiding future preventive strategies. A multidisciplinary approach integrating forensic, medical and social perspectives is necessary to address the multifactorial risks associated with elderly mortality.

Background: Vertebral body dimensions undergo structural alterations with aging, which may contribute to biomechanical instability and increased susceptibility to spinal disorders. Radiological evaluation provides a valuable means to study these morphological changes across age groups. Materials and Methods: A retrospective cross-sectional analysis was conducted on thoracolumbar CT scans of 150 persons aged 20–80 years, categorized into three age groups: Group I (20–39 years), Group II (40–59 years), and Group III (60–80 years), with 50 individuals in each group. Vertebral body height (VBH), anterior-posterior (AP) diameter, and transverse (TR) diameter were measured at vertebrae T12, L1, and L2 using standardized digital calipers. Mean values were compared using one-way ANOVA, with statistical significance set at p < 0.05. Results: Aging was associated with a progressive decline in vertebral dimensions. Mean VBH at L1 decreased from 28.4 ± 1.6 mm in Group I to 25.1 ± 1.9 mm in Group III. Similarly, the AP diameter at L1 declined from 34.2 ± 2.0 mm (Group I) to 30.8 ± 1.8 mm (Group III), while the TR diameter reduced from 42.6 ± 2.3 mm to 38.5 ± 2.5 mm. All differences were statistically significant (p < 0.001). A mild anterior wedge deformity pattern was also more frequently observed in older subjects. Conclusion: The study confirms that vertebral body dimensions decrease significantly with age, particularly in height and transverse diameter. These morphological changes could influence spinal loading and fracture risk in the elderly, emphasizing the need for early identification and preventive measures

Background: Bipolar I Affective Disorder (BPAD-I) is a chronic psychiatric illness characterized by persistent neurocognitive deficits, even during euthymic phases. Recent interest has focused on identifying cognitive endophenotypes by studying unaffected first-degree relatives. Objective: To assess and compare neurocognitive performance across BPAD-I euthymic patients, their unaffected first-degree relatives, and healthy controls. Methods: A cross-sectional study was conducted among 90 participants—30 BPAD-I euthymic patients, 30 unaffected first-degree relatives, and 30 normal controls. Neurocognitive domains were assessed using a comprehensive battery including the Digit Symbol Substitution Test (DSST), Rey’s Auditory Verbal Learning Test (RAVLT), Stroop Test, and Trail Making Test, among others. Statistical analyses involved ANOVA and Tukey’s post hoc tests. Results: BPAD-I patients demonstrated significant impairments across all assessed cognitive domains—processing speed, sustained attention, working memory (verbal and visuospatial), verbal fluency, and executive function (p < 0.0001). First-degree relatives exhibited milder yet statistically significant deficits in several domains, particularly processing speed, verbal working memory, and executive function, when compared to healthy controls (p < 0.05). Conclusion: Neurocognitive deficits in BPAD-I patients persist during remission and are also evident, albeit to a lesser extent, in their first-degree relatives. These findings support the presence of neurocognitive endophenotypes and reinforce the role of heritable cognitive vulnerability in the pathophysiology of bipolar disorder.

Background: Maxillofacial injuries occur commonly in Road Traffic Accidents or falls and assaults. They present with diverse clinical patterns often involving bone and soft tissues of the face. Accurate diagnosis and appropriate management are crucial for optimal functional restoration and facial aesthetics. The current study was designed to determine the clinical presentation, treatment approaches, and outcomes of maxillofacial injuries presented to our hospital. Methods: This prospective study was done in the Department of Plastic and Reconstructive Surgery, Gandhi Medical College and Hospital, Secunderabad. One hundred and fifty patients with maxillofacial injuries following road traffic accidents, industrial accidents, sports injuries, falls from height, assault, animal/human bite presenting to the Emergency Room or outpatient or referred by a neurosurgeon after attending head injury or ruling out brain parenchymal injury and managed in the department of Plastic and reconstructive surgery of Gandhi medical college were included in the study. Results: Out of 150 patients, 143 had facial bone fractures. The mandible was most commonly fractured (91 cases), followed by the nasal, zygoma (44), orbit (41), and maxilla (47). Many had multi-zone fractures (76). Most cases required open reduction and internal fixation (116 patients); others received conservative treatment. Common procedures included Gillie's elevation, miniplate fixation, and IMF. Soft tissue management involves suturing, grafts, or flaps. One facial nerve palsy case was managed with nerve grafting. Five patients developed complications—mostly infections, treated with implant removal or flap coverage. Malocclusion was seen in two cases, managed by redo ORIF or IMF. Conclusion: Within the confines of this study, we found that maxillofacial trauma commonly occurs in young adult males and is frequently caused by RTAs. Mandibular fractures are most commonly involved, followed by maxillary bone, zygomatic bone, and orbital wall fractures. CT is the best and most accurate diagnostic tool for maxillofacial complex injuries. Most cases are managed with open reduction and internal fixation (ORIF). The complication rate in the present study was relatively low.

Background: Necrotizing enterocolitis (NEC) is a devastating bowel disease affecting preterm infants. Surgical intervention is often necessary, but extensive intestinal resection can lead to long-term complications. This study investigates the impact of resection length and histopathological features on intestinal failure and mortality in these infants. Methods: A retrospective cohort analysis of 150 preterm infants with surgically treated NEC was conducted. Data on resection length, histopathology (full-thickness vs. partial-thickness necrosis, inflammatory cell infiltrate, mucosal damage), and outcomes (intestinal failure, mortality) were collected. Univariate and multivariate analyses were performed to assess associations. Results: A longer resection length (>20 cm) and full-thickness necrosis were independently associated with a higher risk of intestinal failure (p<0.001, p=0.004) and mortality (p=0.01, p=0.01) within one year after surgery. Kaplan-Meier survival curves confirmed these findings. Conclusions: Both the extent of intestinal resection and the severity of histologic damage significantly impact long-term outcomes in preterm infants with NEC. Optimizing resection length and considering histopathological features are crucial for optimizing surgical management and post-surgical care strategies.

Objective: This hospital-based cross-sectional study examined serum uric acid and lipid profile levels in ischemic stroke patients and their association with clinical outcomes. The study aimed to determine the prevalence of metabolic abnormalities and their correlation with stroke risk factors and mortality.  Methods: The study included 90 ischemic stroke patients admitted to a tertiary care centre between October 2022 and May 2024. Patients were selected using purposive sampling, with exclusion criteria including hemorrhagic stroke and conditions affecting uric acid levels. Serum uric acid was measured using the Uricase-PAP method, while lipid profiles (total cholesterol, LDL, HDL, triglycerides) were analyzed colourimetrically. Statistical analysis was performed using Epi Info v7, with significance at p<0.05. Results: The study population was comprised predominantly of elderly (74.4% >50 years) males (57.8%). Common comorbidities like hypertension (42.2%) and diabetes (38.9%) were reported. Hyperuricemia was present in 37.8% of patients, while dyslipidemia was prevalent (elevated LDL: 52.2%; high triglycerides: 54.4%). Hyperuricemia showed strong associations with hypertension (OR=15.35, p<0.001), diabetes (OR=4.85, p<0.001), and dyslipidemia (OR=3.44-6.00, p≤0.008). However, no significant correlation was found between uric acid levels and age, sex, or addictions (p>0.05). Mortality analysis revealed no significant association between abnormal metabolic parameters and outcomes (p>0.29), though 60% of deceased patients had hyperuricemia. Conclusion: The study highlights the high prevalence of metabolic abnormalities in ischemic stroke patients, with hyperuricemia strongly associated with hypertension, diabetes, and dyslipidemia. While these factors did not significantly predict short-term mortality, their frequent co-occurrence suggests shared pathological mechanisms. These findings emphasize the importance of comprehensive metabolic evaluation in stroke management and the need for further research on uric acid's prognostic value. 

Background: Depression is a common psychiatric disorder, and the quest for alternative therapies with medicinal plant extracts has become important. Azadirachta indica (Neem) has long been used therapeutically in traditional medicine. The present investigation was designed to assess the antidepressant activity of methanolic extract of leaves of Azadirachta indica (MELAI) in albino mice and investigate its potential mechanism of action. Methods: An experimental study was conducted using 25 mice, divided into five groups: normal control, disease control (reserpine 2 mg/kg), standard (fluoxetine 10 mg/kg), and two test groups receiving MELAI (250 mg/kg and 500 mg/kg). Depression was induced using reserpine, and antidepressant activity was assessed using the Forced Swim Test (FST) and Tail Suspension Test (TST). Statistical analysis was performed using ANOVA followed by Bonferroni’s multiple comparison test. Results: MELAI decreased immobility time in FST and TST significantly (p<0.001) in a dose-related fashion, with the larger dose (500 mg/kg) being more effective. The action, though less than fluoxetine, implicates action in central monoaminergic mechanisms. Phytochemical examination disclosed flavonoids, tannins, polyphenols, and alkaloids, suggesting an antioxidant activity. Tannic acid and nimbosterol may also be involved in the antidepressant effect. Conclusion: MELAI showed marked antidepressant activity, which is most probably mediated by antioxidant and monoaminergic mechanisms. Additional studies are required to determine its exact mechanism of action and possible clinical uses.

Background: Induction of labor is a frequent obstetric intervention, and its success is greatly dependent on cervical ripeness. The Bishop's score, although in common use, is subjective and of limited prognostic value, particularly in women with an unfavorable cervix. Transvaginal ultrasonographic cervical length assessment provides an objective tool to determine cervical status prior to induction. The present study investigates the utility of pre-induction transvaginal cervical length assessment in determining the mode of delivery. Methods: This potential observational study was carried out in ESIPGIMSR, Chennai, from January 2012 to November 2013. 250 pregnant women with singleton cephalic pregnancies at 37–42 weeks of gestation and a Bishop's score of less than 4 were included. Transvaginal measurement of cervical length prior to labour induction with PGE2 gel was done. Association between cervical length and outcomes of delivery was compared. Results: A cervical measurement of <2.65 cm was strongly predictive of successful vaginal delivery, being 97.4% sensitive and 97.8% specific. Within women with measurements of <2.65 cm, 97.8% delivered vaginally, whereas 97.4% of the women with lengths >2.65 cm underwent caesarean section. The mean interval from induction to delivery was 20.1 hours, the latent phases of which were briefer within women who experienced vaginal birth. Neonatal condition was good with a mean birth weight of 2.69 kg and Apgar score of 8/10 in the majority of cases. Conclusion: Transvaginal measurement of cervical length is a strong predictor of vaginal delivery and may be used as a valuable component in labour induction strategies. It gives objective, reproducible results that improve clinical decision making in obstetric practice.

Background:  Lumbar discectomy is a widely performed surgical procedure for lumbar disc herniation, offering significant pain relief and functional improvement. While primary discectomy is generally successful, some patients experience recurrent herniation requiring revision surgery. Revision discectomy is often more complex due to scar tissue, altered anatomy, and increased risk of complications. Understanding differences in outcomes between primary and revision procedures is essential for guiding surgical decision-making, managing patient expectations, and improving long-term results in lumbar spine surgery. Methods: Patient demographics included age, sex, body mass index (BMI), and smoking status. Clinical variables comprised preoperative assessments using the Visual Analog Scale (VAS) for leg and back pain and the Oswestry Disability Index (ODI), along with the duration of symptoms before surgery. Surgical parameters recorded included operative time, estimated blood loss, and intraoperative complications such as dural tears and nerve root injuries. Primary outcomes were defined as a ≥50% reduction in VAS scores and a ≥20-point improvement in ODI at 6 and 12 months postoperatively. Secondary outcomes included reoperation rates, postoperative complications like infection or hematoma, and patient satisfaction measured using a Likert scale. Results: In this comparative study, both groups were demographically similar, with no significant differences in age (p=0.15), sex (p=0.56), BMI (p=0.21), or smoking status (p=0.52), except for longer symptom duration in the revision group (8.5 ± 3.3 vs. 6.2 ± 2.1 months, p=0.01). Revision surgeries had longer operative times (112 ± 28 vs. 68 ± 15 minutes, p<0.001), greater blood loss (185 ± 42 vs. 45 ± 18 mL, p<0.001), more dural tears (20% vs. 4%, p=0.04), and higher neuromonitoring alerts (16% vs. 0%, p=0.02). Postoperative improvements were greater in the primary group for VAS leg pain (Δ4.7 vs. Δ3.9, p=0.03) and ODI (Δ44.1 vs. Δ32.4, p=0.001). Hospital stay and return-to-work time were significantly shorter in the primary group (p<0.001). Conclusion: In conclusion, within the limitations of the current study we found that revision lumbar discectomy can provide substantial symptomatic relief, it carries increased operative risk and yields less favorable outcomes compared to primary discectomy. These findings emphasize the need for careful surgical planning and patient counseling.

Background: Diabetes mellitus compromises immune function, predisposing individuals to various infections, including pleuropulmonary infections. These infections, such as pneumonia, lung abscess, and empyema, are more frequent and severe in diabetic patients due to hyperglycemia-induced immune dysfunction, impaired mucociliary clearance, and altered pulmonary microcirculation. The clinical presentation may be atypical, delaying diagnosis and treatment. Understanding the spectrum and outcomes of pleuropulmonary infections in diabetics is crucial for early recognition, effective management, and preventing complications, thereby improving overall patient prognosis. Methods: The study included adult patients (aged ≥18 years) diagnosed with diabetes mellitus (type 2) who presented with clinical and radiological features suggestive of pleuropulmonary infections. Patients with a confirmed diagnosis of diabetes mellitus as per American Diabetes Association criteria. Patients presenting with signs and symptoms suggestive of pleuropulmonary infections such as fever, cough, dyspnea, chest pain, and radiological evidence of pneumonia, pleural effusion, empyema, lung abscess, or pulmonary tuberculosis. Results: 70 patients with type 2 diabetes mellitus were included in the study. The mean age was 58.4 years, with a mean diabetes duration of 7.5 years and poor glycemic control (mean HbA1c 9.1%). Common symptoms included fever (92.8%), cough (82.9%), and dyspnea (67.1%). Community-acquired pneumonia was the most frequent infection (64.3%), followed by tuberculosis (25.7%). Radiologically, consolidation was common (55.7%). Streptococcus pneumoniae and Klebsiella pneumoniae were the predominant pathogens. Most patients (74.3%) recovered, while poor outcomes were associated with HbA1c >9%, bilateral infiltrates, and CKD. Conclusion: In conclusion, pleuropulmonary infections in diabetics present diverse clinical and radiological features and are commonly caused by typical bacterial and mycobacterial pathogens. Poor glycemic control and comorbid conditions are key factors influencing disease severity and outcomes.

Background: Preoperative education is an essential aspect of patient-centered surgical care, particularly in orthopedic procedures where recovery heavily depends on patient compliance and understanding. Aim: To evaluate the effectiveness of structured preoperative education programmes on patient satisfaction, anxiety levels, and postoperative surgical outcomes in elective orthopedic surgeries. Materials and Methods: This prospective observational study included 100 patients scheduled for elective orthopedic surgeries.  Participants were divided into two groups: Group A received structured preoperative education, while Group B received routine instructions. Anxiety levels (STAI), pain scores (VAS), time to mobilization, length of hospital stay, complication rates, and patient satisfaction were assessed and statistically analyzed. Results: Group A exhibited significantly lower anxiety (mean STAI: 28.2 vs. 35.4; p < 0.001), lower pain scores (VAS: 4.1 vs. 5.6; p < 0.001), earlier mobilization (22.3 hrs vs. 28.6 hrs; p < 0.001), and shorter hospital stays (4.8 vs. 6.2 days; p < 0.001). Patient satisfaction was higher in Group A (mean score: 8.6 vs. 6.7; p < 0.001). Conclusion: Structured preoperative education significantly improves patient satisfaction, reduces anxiety, and enhances recovery outcomes in elective orthopedic surgeries. Its integration into standard care protocols is highly recommended.

Background: Carcinoma of the buccal mucosa is an aggressive oral cancer with aggressive morbidity and recurrence. Surgical therapy continues to be the mainstay of treatment, usually with adjuvant therapy. This paper assesses the complications and results of surgical therapy for buccal mucosa carcinoma at a tertiary referral center. Methods: A retrospective study of 120 patients who had undergone surgery for buccal mucosa carcinoma was performed. Demographics of the patients, clinicopathological characteristics, postoperative complications, and patterns of recurrence were examined. Statistical comparisons with existing literature were made to determine the efficacy of treatment. Results: The cohort consisted of 85 men (70.8%) and 35 women (29.2%), with a mean age of 54.3 years. Advanced-stage disease (T3-T4) was seen in 70.8% of cases. Surgical complications developed in 35% of the patients, most commonly surgical site infections (12.5%), flap necrosis (7.5%), and orocutaneous fistula (6.7%). Median hospital stay was 10 days, which went up to 15 days in the complication group. At median follow-up of 18 months, 81.7% were disease-free, and 18.3% had recurrence. Adjuvant radiotherapy was given to 60% of the patients, of which 23.3% were given concurrent chemoradiation. Conclusion: Surgery for buccal mucosa carcinoma is carried with a high risk of complications and recurrence, especially in the advanced stages. Perioperative care that is complete, nodal treatment that is aggressive, and adjuvant therapy that is maximized are key to enhancing outcomes for patients. Detection strategies at an early stage and treatment protocols that are refined need to be utilized to improve survival and quality of life.

Background: Dementia is a progressive disorder that impairs cognitive function and daily living. Early diagnosis is vital, yet the effectiveness of screening tools remains debated. The HMSE, MoCA, and ACE-III are commonly used, but their diagnostic accuracy, especially in Hindi-speaking populations, is not well established. Aim: This study aimed to compare the diagnostic accuracy of the HMSE, MoCA, and ACE-III in detecting dementia. Method: This cross-sectional study was conducted at tertiary care centre from January 2024 to January 2025. A total of 190 participants (100 dementia patients and 90 cognitively healthy controls) underwent assessment using HMSE, MoCA, and ACE-III. Sensitivity, specificity, and receiver operating characteristic (ROC) curve analyses were performed to determine the optimal cutoff scores and diagnostic accuracy of each test. Pearson’s correlation coefficient was used to assess the relationship between the three screening tools. Result: ACE-III demonstrated the highest diagnostic accuracy (AUC = 0.93), with an optimal cutoff score of 71, yielding a sensitivity of 91% and specificity of 89%. MoCA showed good diagnostic performance (AUC = 0.90, cutoff = 23, sensitivity = 87%, specificity = 85%), while HMSE had the lowest accuracy (AUC = 0.85, cutoff = 24, sensitivity = 83%, specificity = 80%). Strong correlations were observed between ACE-III and MoCA (r = 0.87, p < 0.001). Conclusion: ACE-III is the most accurate screening tool for dementia detection, followed by MoCA, while HMSE, though useful, has lower sensitivity and specificity. The findings support the adoption of ACE-III in clinical settings, with MoCA as a practical alternative for time-constrained assessments. Further studies should explore education-adjusted cutoff scores for improved diagnostic precision.

Background: The Pap smear has been a cornerstone of cervical cancer screening for decades, yet its diagnostic accuracy remains under scrutiny as screening strategies evolve. This study evaluates the clinical correlation between Pap smear results and histopathological findings to assess its effectiveness in detecting cervical abnormalities. Methods: A retrospective cohort study analysed 500 patient records from a tertiary care hospital (January 2020–March 2024). Women aged 21–65 with documented Pap smears and subsequent biopsies within six months were included. Pap smear results were classified per the Bethesda System (NILM, ASC-US, LSIL, HSIL, SCC), and biopsy outcomes (normal, CIN I–III, invasive carcinoma) served as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, with statistical significance assessed via chi-square testing. Results: Of 500 cases, 320 (64%) Pap smears were NILM, and 180 (36%) were abnormal (60 ASC-US, 70 LSIL, 40 HSIL, 10 SCC). Biopsies confirmed 400 (80%) negative and 100 (20%) positive cases (50 CIN I, 30 CIN II–III, 20 invasive carcinomas). Sensitivity was 87.5% (95% CI: 80.2–93.1%), specificity 92.3% (95% CI: 89.0–94.9%), PPV 78.6% (95% CI: 71.0–85.1%), and NPV 95.7% (95% CI: 93.0–97.6%). False negatives (12 cases) included NILM with CIN II–III or carcinoma, while false positives (31 cases) were predominantly ASC-US/LSIL with normal histology. LSIL showed the highest discordance (17.1% underestimated CIN II–III). A strong correlation was observed (χ² = 315.4, p < 0.001). Conclusion: The Pap smear demonstrates high sensitivity and specificity, excelling at ruling out disease, but its moderate PPV and LSIL discrepancies suggest limitations. Adjunctive methods like HPV testing could enhance screening accuracy, supporting a hybrid approach to optimize cervical cancer prevention.

Background: Urinary tract infections (UTIs) are clinically relevant problem for patients with diabetes mellitus (DM). Many UTIs are asymptomatic especially in women. Hence a study was conducted to estimate the prevalence of asymptomatic bacteriuria among women with DM and also to identify the causative organisms with its antibiogram. Methods: It was a prospective research conducted in the department of general medicine, Sri Pingali venkaiah government medical college(spvgmcggh), Machilipatnam, Andhra pradesh. Study was conducted between july2023 and august2023 for a period of one year. Women with DM were included in this research. Women with symptoms of UTI, those catheterised 2 months before the study, those proceeded for urogenital instrumentation 2 months before the study, pregnant women, those used antibiotics 14 days prior to the study, those with gynaecological infections, non-cooperative women were not considered in this research. The participants were thoroughly explained about the collection of mid-stream urine (MSU). Nursing assistance was also provided for elders. Urine was collected in a sterile wide mouthed screw cap bottle for culture as well as microscopy. Culture of urine specimen, identification of the pathogens along with antimicrobial sensitivity were carried as per the guidelines. Results: Total 200 members were included in the test and 75 in control group; mean age was 52.2± 11.5 and 51.7 ± 11.9 years, respectively. The rate of significant bacteriuria (SB) was 68 and 6, respectively in the groups (Table 1). In the test group, Escherichia coli (56; 82%) was the leading causative agent followed by Klebsiella pneumoniae (6), coagulase negative staphylococcus (Co NS). Majority isolates from diabetic women were susceptible to conventional antimicrobial drugs. Conclusion: This study showed that the prevalence of asymptomatic bacteriuria is higher in diabetic women, age is an important risk factor. Longer duration of diabetes has increased risk of asymptomatic bacteriuria

Background: A penetrating abdominal injury is caused due to the mechanical force of a foreign object breaching the skin in the abdominal area and inflicting damage to the structures in its path and resulting in an open wound. Present study was aimed to study clinical presentations, patterns, management modalities and its outcome in patients of penetrating injuries to abdomen. Material and Methods: Present study was a prospective observational study, done in patients admitted to trauma care centre and general surgery ward with history of penetrating trauma to abdomen. Results: 107 patients were included in present study. Majority were from 21-30 (33.9%) years age group, were male (96.5%) and had h/o stab injury by sharp objects 98 (91.6%). At the time of presentation majority patients were hemodynamically stable (51.4 %), had peritonitis (77.6%) and only 12 (11.2%) patients had evisceration at the time of presentation. Common associated injuries were head injury (9.3%), chest injuries (3.7%) & injury to extremities (3.7%) In this study among  penetrating injuries to abdomen, organs involved were small bowel (50.5 %), large bowel (21.5 %), liver (14 %), mesentery (13.1 %), stomach (4.7 %), spleen (2.8 %), duodenum (1.9 %), pancreas (1.9 %) & kidney (0.9 %).According to this study 98 patients were discharged and 9 patients died (mortality was 8,4%). Conclusion: In patients of penetrating trauma to abdomen, early diagnosis and early surgical management leads to better outcome. The results are favourable when there I is good teamwork backed by good critical care set-up.

Background: Anastomotic leakage (AL) is a severe complication following colorectal surgery, significantly impacting morbidity, mortality, and healthcare costs. This study aimed to identify the incidence and explore potential risk factors associated with AL in a cohort of patients undergoing colorectal surgery. Methods: We conducted a cross-sectional study involving 120 patients who underwent colorectal surgeries at a single tertiary care center. Data were retrospectively collected from patient records including demographic information, clinical characteristics, surgical details, and postoperative outcomes. Statistical analysis involved chi-square and t-tests, with logistic regression used to identify factors significantly associated with the development of AL. Results: The incidence of AL in our study population was 12%. Significant risk factors for AL included age (P=0.0108), high body mass index (BMI) (P=0.0433), male gender (P=0.0488), smoking status (P=0.0185), high American Society of Anesthesiologists (ASA) score (P=0.0173), emergency surgery (P=0.0222), and increased intraoperative blood loss (P=0.0310). Minimally invasive surgical techniques and effective perioperative management, including the use of drains and antibiotic prophylaxis, were associated with lower rates of AL. Conclusion: Anastomotic leakage remains a critical issue in colorectal surgery with specific modifiable and non-modifiable risk factors influencing its occurrence. Identification and preemptive management of these risks could improve patient outcomes. Future research should focus on prospective validation of these findings and the development of targeted interventions to mitigate the identified risk factors.

Background: Total Knee Arthroplasty (TKA) is a well-established procedure for managing end-stage osteoarthritis. However, the need for joint replacement often arises prematurely in patients with focal cartilage damage. Arthroscopy-guided cartilage preservation (AGCP) presents a minimally invasive alternative aimed at delaying the need for TKA by preserving joint integrity and promoting tissue regeneration. This study aims to evaluate the efficacy of AGCP in enhancing knee function and delaying the requirement for TKA. Materials and Methods: A prospective, randomized clinical trial was conducted involving 100 patients with grade II-III knee osteoarthritis according to the Kellgren-Lawrence scale. Participants were divided into two groups: Group A (n=50) underwent AGCP involving debridement, microfracture, and chondroplasty, while Group B (n=50) received standard conservative treatment (physiotherapy and medication). Clinical outcomes were assessed at baseline, 6 months, and 12 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) for pain. Magnetic Resonance Imaging (MRI) was performed to evaluate cartilage integrity. Statistical analysis was performed using paired t-tests and ANOVA, with p < 0.05 considered significant. Results: At 12 months, Group A demonstrated a significant improvement in KOOS scores (mean improvement: 40 points, p < 0.001) compared to Group B (mean improvement: 15 points, p < 0.05). VAS pain scores were reduced by an average of 4 points in Group A, whereas Group B showed a reduction of 1.5 points. MRI findings indicated enhanced cartilage thickness in Group A (mean increase: 1.2 mm) compared to Group B (mean increase: 0.3 mm). Overall, 80% of patients in Group A reported improved joint function and satisfaction, with only 10% progressing to TKA within the study period. Conclusion: Arthroscopy-guided cartilage preservation appears to be a promising approach for delaying the need for Total Knee Arthroplasty in patients with moderate osteoarthritis. The technique demonstrates substantial improvement in pain relief, cartilage regeneration, and overall knee function. Further long-term studies are warranted to validate these findings and refine the AGCP technique.

Background: Although children with COVID-19 often have moderate symptoms when they first arrive, there is growing evidence of consequences including acute kidney injury (AKI), particularly in children who are hospitalised. Data on AKI prevalence, risk factors, and outcomes in paediatric populations in resource-constrained environments infected with COVID-19 are few. Objective: To estimate the prevalence of AKI, identify associated risk factors, and evaluate short-term outcomes among hospitalized children with COVID-19. Methods: A retrospective descriptive study was conducted at Indira Gandhi Institute of Child Health, Bangalore, from January 2022 to August 2022. Clinical data of 210 hospitalized children (aged 1 month to 18 years) with confirmed COVID-19 by RT-PCR were reviewed. AKI was diagnosed using KDIGO 2012 criteria. Statistical analysis included descriptive statistics and multivariate regression to identify predictors of AKI and mortality. Results: The prevalence of AKI among hospitalized children with COVID-19 was 18.1% (38/210 cases). Risk factors included severe COVID-19 (p=0.001), multisystem inflammatory syndrome in children (MIS-C) (p=0.005), and pre-existing chronic kidney disease (p=0.02). AKI was associated with longer hospital stays (p=0.003), higher ICU admissions (p=0.001), and increased mortality (p=0.004). Conclusion: AKI is a significant complication in hospitalized children with COVID-19. Early identification of risk factors may improve management and outcomes.

Background: Thalassemia and sickle cell disease are two prevalent hemoglobinopathies with distinct genetic etiologies but overlapping clinical manifestations. Accurate differentiation between these conditions is crucial for appropriate management and treatment. Objectives: This study aims to evaluate and compare the hemoglobin variants in HPLC from patients with thalassemia and sickle cell disease, providing insights into differential diagnosis and aiding in clinical management. Methods: We conducted a cross-sectional analysis of 80 patients (40 with thalassemia and 40 with sickle cell disease) at a tertiary care center. HPLC reports were analyzed to identify and quantify hemoglobin variants such as Hemoglobin A, S, F, and A2. Statistical analysis was performed to compare the prevalence of these variants between the two patient groups. Results: The study revealed significant differences in the distribution of hemoglobin variants between thalassemia and sickle cell disease. Hemoglobin A was predominantly observed in thalassemia patients (mean 9.4 g/dL, SD 1.2), whereas sickle cell disease was characterized by a higher percentage of Hemoglobin S (mean 78.3%, SD 8.1). Hemoglobin F and A2 also showed significant variations, supporting their roles in modifying disease expression and severity. Conclusions: The distinct profiles of hemoglobin variants identified in this study confirm the efficacy of HPLC in differentiating between thalassemia and sickle cell disease. This differentiation is vital for tailoring patient management strategies and highlights the need for precise diagnostic techniques in routine clinical practice.

Aim: To elucidate the findings in a rare yet potentially morbid course of presentation of ventral umbilical hernia and Pseudomyxoma Peritonei (PMP),  which has an annual incidence of 1 to 4 in a million annually [1]. Background:  Mucinous content in an umbilical hernia is rarely reported. It must be recognized and evaluated to rule out the insidious pathology and incidence of PMP, a condition characterized by mucinous ascites due to a ruptured mucinous tumour, typically of appendiceal or ovarian origin [2]. Case Description: We present the case of a 73-year-old male patient who presented with an umbilical hernia without any signs of significant distension. The patient was posted for open umbilical hernioplasty after thorough evaluation. Intraoperatively, 1.5L of 
mucinous material was identified and aspirated. Postoperative histopathological examination of the peritoneal biopsy revealed abundant acellular mucin with features suggestive of reactive mesothelial hyperplasia, confirming the presence of a low-grade mucinous neoplasm, with no evidence of invasive carcinoma and a normal appendix. Given the patient's age and comorbidities, palliative care was opted. We report a rare case of an umbilical hernia with a mucinous surprise. Conclusion: Umbilical hernia with mucinous content, revealing a diagnosis of PMP of unknown origin, is a rare entity that must be evaluated and identified early.

The rise in global obesity has intensified the need for effective pharmacological interventions that go beyond weight loss to target underlying metabolic dysfunctions. New weight loss drugs—particularly GLP-1 receptor agonists and dual GIP/GLP-1 agonists like tirzepatide—demonstrate promising results in improving multiple metabolic health markers. This systematic review explores their efficacy in regulating glycemic control, improving insulin sensitivity, lowering lipid levels, reducing liver fat, and suppressing inflammatory markers. These agents show particular benefit for individuals with metabolic syndrome, type 2 diabetes, and non-alcoholic fatty liver disease. While clinical trials report encouraging outcomes, questions remain regarding long-term safety, accessibility, and cost. Continued research is vital to define their optimal use in chronic disease prevention and public health strategies.

Liver abscess, has a very long historic and Medical background mentioned in very old literature  ( 3000 BC). A right hypochondriac, or epigastric or left upper quadrant abdominal pain, may have high mortality and morbidity because of some complications, if early diagnosis and management  is not done in a given patient. In world literature mainly two major descriptions for aetiology  is known, amoebic and pyogenic. The objective of the present study is to assess the changing trends in clinical patterns, etiological factors, microbiological aetiology and management in patients with liver abscess in a tertiary care hospital. . A total of 50 patients were enrolled in the study. In our study 70 % patients had Amoebic liver abscess and 30 % had Pyogenic liver abscess. 52% cases were managed by conservative treatment, 16 % by Percutaneous aspiration and 20 % by Percutaneous drainage, 12 % by Open Laparotomy. 8 patients developed complications. 4 had rupture, 2 had pleural effusion and 2 had Septicaemia. Liver abscess is a frequently encountered surgical issue in contemporary clinical practice. It causes significant discomfort to patients and prolongs morbidity in those who are not handled correctly or who develop problems. It creates a significant conundrum since management protocols are not properly established. There are an expanding variety of available novel therapeutic techniques

Background: Scrub typhus is a re-emerging infectious disease with nonspecific clinical presentations, ranging from prominent pulmonary manifestations. Because it presents nonspecifically and can mimic other endemic febrile conditions such as malaria and dengue, early diagnosis is difficult. The present study seeks to assess the pulmonary presentations and biochemical abnormalities of scrub typhus patients. Methods: A one-year retrospective study of 100 patients diagnosed with scrub typhus on IgM IFA was done. Clinical presentation, laboratory values, radiographic abnormalities, and outcomes of treatment were compared. Results: Abnormal chest imaging results were found in 37% of the 100 patients. Bilateral pleural effusion (67.5%) was the most frequent abnormality followed by ground-glass opacities (40.5%) and consolidation (24.3%). Acute kidney injury was seen in 43.2% and transaminitis in 37.8%. Hyponatremia (70.2%) was the commonest electrolyte derangement. The average level of CRP was 155.39 mg/L, of which 37.8% had CRP >150 mg/L. ARDS developed in five patients (13.5%), all of whom died irrespective of early treatment with doxycycline. Conclusion: Pulmonary involvement in scrub typhus is an important cause of morbidity and mortality. With its nonspecific presentation, increased clinical suspicion is important for the early diagnosis. The finding of raised CRP levels, pleural effusion, and ground-glass opacities should lead to consideration of scrub typhus in febrile patients with respiratory illness. Enhanced awareness and research are necessary to improve diagnostic and therapeutic approaches.

Background: Surge in invasive fungal rhino-sinusitis during COVID-19 pandemic imposed as life-threatening complication. Even after overcoming pandemic, there is definite rise in cases compared to pre-pandemic incidence. Emergence of newer variants will only make conditions worse as population is already heavily burdened with exposure to previous variants, COVID-19 vaccines, injudicious steroids, anti-fungal and antibiotics usage, uncontrolled diabetes, hypertension. Methodology: Case series on 8 microbiologically confirmed cases of invasive fungal rhino-sinusitis amongst 25 clinically suspected who attended ENT OPD or were admitted in inpatient department for span of six months, i.e. from October 2023 to March 2024. We aim to identify risk factors for sudden surge, microorganism prevalence pattern and associated co-infection patterns. Results: 3 males and 5 females of age group 20 - 70 years old were studied. 7 had uncontrolled diabetes with average Hba1c level of 11. All were completely vaccinated for COVID-19 and 4 were previously COVID infected. Mucor group found to be predominant, followed by Aspergillus affecting primarily inferior turbinate, majorly maxillary and ethmoid sinuses. Disease extension for all were rhino-orbital with lateral rectus palsy and few with co-infection of Acinetobacter species. Conclusions: A significant surge in cases from pre-pandemic incidence of 14% to currently 32%. Major risk factor included uncontrolled diabetes, previous history of COVID infection and steroid usage. Vaccination against COVID didn’t seem to play protective role, however data is too less to make adequate conclusion. The disease is of utmost importance due to increased burden of mortality, hence timely diagnosis, surgical and medical management is crucial.